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Thoracic Pain (Mid back pain) is a complicated area to focus on as it covers such a broad spectrum of possibilities. Not only is there lots of over laying muscles, but this area, along with the rib cage houses our bodies vital organs and therefore, pain should not be over looked without proper investigation.

In clinic there are a few common presentations I see often, which all fall under a musculoskeletal cause. In other cases there are many visceral and internal causes of thoracic pain which I've focused on below as well.

Below is a list of common MSK problems causing mid back pain: 
● Disc Herniation
● Nerve Root irritation/ Impingement
● Fractured vertebra from trauma
● Osteoarthritis 
● Rheumatoid Arthritis 
● Muscle Strain
● Ligament Sprain
● Scoliosis
● Postural Changes

Symptoms can be:
● Pain- described as ache/ stiffness
● Burning
● Pins and needles
● Numbness
● Weakness
● Pain on Coughing/ Sneezing
● Difficulty bending forward, twisting or arching back

Regarding the Pain:
1) Do you have moments of ease?
2) Are there specific movements that make it worse?
3) Can you identify/touch the area of pain?
4) Is there a clear cause of the onset of the pain?

If the answer is NO to all these questions, it starts to suggest:
1) The Pain is unremitting (constant) 
2) The Pain is Non mechanical (eg less likely to be a musculoskeletal cause)
3) The Pain is internal and “Deep”
4) The Pain started for no reason and has an insidious cause

All of which suggest red flags for back pain, other symptoms to be aware of:
● Fever
● Chills
● Abdominal pain
● Difficulty Breathing
● Dizziness
● Nausea Vomiting
● Rapid Heart Rate
● Unexplained Weight Loss
● Bladder / Bowel changes – pain, blood, difficulty

Taking into account all the symptoms above, signs point to an internal cause of the mid back pain, below is a simplified list of possible causes:
● Lung 
● Oesophagus
● Stomach
● Liver
● Gall bladder
● Pancreas
● Kidneys

All these structures can cause referred pain to the mid back area down to the upper, lower back.

If you are experiencing anything discussed above, please seek medical attention immediately for further investigation.

Thoracic Pain (Upper & Mid Back): Resources
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